[The place of radiosurgery in the treatment of hypophyseal adenoma].

Since 1984, the neurosurgical team of Sainte-Anne Hospital in Paris has taken in charge almost 750 patients for linear accelerator radiosurgery. But only a small percentage of them were harbouring a pituitary tumor. That is why the present paper is based mostly on literature data. Pituitary adenoma radiosurgery (RS) is a second intention therapeutic method. It should be recommended only after failure of medical and/or surgical treatment. Two main methods can be used: linear accelerator-radiosurgery and Cobalt-60 gamma unit. Both procedures provide equivalent results in terms of dosimetry, accuracy and clinical data. Results of various series presented in recent and updated literature have been studied and analysed. They show and confirm the efficiency of radiosurgery on tumor and hormone secretion controls, with few cases of pituitary insufficiency. However, results were disappointing concerning visual disorders, particularly if visual dysfunction and impairment existed before radiosurgery. All authors agree nowadays on different points: a) indications: invasive adenomas, with an incomplete resection, or adenomatous recurrences, b) contraindications: tumoral size > 20 mm, distance to visual pathways < 5 mm, c) imperative precautionary measures: less than 8 Gray must be delivered on visual pathways, less than 40 Gray on oculomotor nerves. In some cases, stereotactic fractioned radiotherapy may be an alternative treatment for large tumors close to visual pathways.